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Pitt insomnia study finds some regions of the brain don't shut off completely during sleep

| Wednesday, Oct. 5, 2016, 7:21 p.m.
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University of Pittsburgh researchers have shown with brain scans what many insomniacs already report about their sleep: that it is disturbed by wandering thoughts, self-reflection and heightened self-attention.

The finding, published this week in the October edition of the journal SLEEP, could help advance the idea that insomnia is more than a psychological condition related to anxiety and worry, said Dr. Daniel Buysse, a study co-author and professor of psychiatry and clinical and translational science at Pitt.

The study compared brain activity of people with insomnia and people without it during and after sleep. Researchers found that the insomniacs had higher-than-normal activity in the affected regions during sleep and lower-than-normal activity while awake.

“What we found is that the people with insomnia have regions of their brain that seem to not shut off as completely when they're asleep,” Buysse said.

The study, which included 44 people with insomnia and 40 without it, strengthens evidence from a similar study at Pitt that included 6 people with insomnia and 14 without it, he said. The study hasn't proven a cause-and-effect connection between the brain activity and insomnia, Buysse said. The brain activity could be an effect of changed thought patterns, or vice versa.

Buysse said that the brain scans are linked to insomniacs' own descriptions of their problems sleeping. Identifying the brain regions correlated with their thought patterns could help researchers target the regions to improve treatment, he said.

The most prominent treatments now are drugs and cognitive behavioral therapy for insomnia, which aims to establish regular sleep-wake schedules and limit time spent in bed to try to induce better sleep.

The brain scans suggest that treatments such as transcranial magnetic stimulation, which activates specific brain regions, could be helpful, Buysse said. Treatment would likely stimulate the brain during waking hours to try to tire it out for sleep — but those strategies remain untested, he said.

The study supports continued use of another treatment, known as mindfulness meditation, which has been shown to decrease activity in brain regions affected by insomnia, he said. The strategy encourages insomniacs to accept the thoughts going through their heads instead of trying to control them, a common behavior of the disorder.

Chronic insomnia, defined as at least three consecutive months of sleeping problems, affects 5 to 10 percent of adults, Buysse said. The disorder is associated with fatigue, inattention, irritability, poor mood, depression, anxiety disorders, substance use and cardiovascular disease, he said.

“It has some real long-term health correlates,” he said. “We can't say it's cause and effect, but it does increase your risk for those other conditions.”

The study's implications for the links between insomnia and depression were particularly striking to Jennifer Martin, an associate professor of medicine at UCLA who specializes in insomnia and is not associated with the Pitt study.

There's more evidence that treating insomnia makes depression go away rather than treating depression makes insomnia go away, she said, but the relationship between the two is not well understood. The study suggests that changes in brain activity could lead to insomnia, which leads to depression.

“This may be a brain phenomenon and not just the fact that not sleeping well makes you sad,” she said.

But other causal changes are possible, she emphasized, and more study is needed.

Buysse said his team is analyzing the data to study how interventions such as cognitive behavioral therapy affect brain patterns, and they plan to more closely study the links between complaints of how long it took to fall asleep and activity in specific brain regions.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.

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